trauma patients with severe bleeding are usually composed of three blood
components: platelets, plasma and red blood cells (RBC). But debates have
always raged on among the medical personnel in emergency care about the best
ratio of blood components to be given to such patients.
A new study from
the University of Texas Health Science Center showed that a blood
with a balanced ratio of plasma, platelets, and RBCs were
more likely to stop bleeding compared to a transfusion with a higher ratio of
found no major difference in mortality rates when comparing these two
widely-used transfusion procedures.
Lead author Dr.
John B. Holcomband his research team conducted a study involving 680 severely
injured patients who arrived at one of their trauma centers. Patients who were
predicted to require massive transfusion were randomly assigned to receive two
widely-used procedures during active resuscitation, in addition to all local
used a blood component ratio of one platelet, one plasma
and one RBC (1:1:1) and other used a component ratio of one platelet, one plasma and two RBCs (1:1:2).
Despite the apprehension that the balanced blood ratio group
might experience higher rates of multiple inflammatory-mediated issues such as
sepsis, blood clots, infection and acute respiratory distress syndrome
, no major
differences were identified between the two treatment groups.
show that extensive loss of blood (exsanguination), which was the main cause of
death within the first 24 hours after a serious injury to the body, was
significantly decreased in the 1:1:1 group. This is approximately 9.2% vs 14.6%
in 1:1:2 group. Also 86% patients achieved hemostasis, the stoppage of
bleeding, in the 1:1:1 group compared to 78% in the 1:1:2 group.
concluded that clinicians should consider using a 1:1:1 transfusion protocol,
given the lower percentage of deaths from exsanguination and their failure to
find differences in safety.
should start with the initial units transfused while patients are actively
bleeding, and then transitioning to laboratory-guided treatment once hemorrhage
control is achieved. Future studies of hemorrhage control products, devices,
and interventions should concentrate on the physiologically relevant period of
active bleeding after injury and use acute complications and later deaths (24
hours and 30 days) as safety end points," the authors write.
The study was online in the
Journal of the American Medical Association